Document BRD3mbgnpn4L5Ebr4n9oRjwXm
FILE NAME: Contract Unit Workers Comp Claims (WCC)
DATE: 1961
DOC#: WCC009
DOCUMENT DESCRIPTION: Workers Comp File - Shepard, James Contains all documents found in the Claimant's file, with one blank page between each separate document
/
BAUTIMilfRE NEW fORK
% /
CLARKSBURG*4'
TULSA
.*
ST. LOUISjjfF
C H IC A G O .
'L O S ANGELES
' ATLAN
`.PITTSBURGH
SAN* FRANCISCO
NEW ORLEANS
MIAMI
PHILADELPHIA
A l J B X A XS D I B R Si Al ^IEXAWITDIEM
INCORPORATED
INSURANCE
>
AVERAGE ADJUSTERS
CONSULTING ACTUARIES
2225 NORTH C H A R L E S STREET, BALTI MOR E 18, MD.
June 8, 1961
TELEPHONE TUXEDO 9-4304
BELL SYSTEM TELETYPE BA 562
CABLE ADDRESS "ALEXBLUE"
MInrs.uWranilclieamDeLp.arHtmuegnhtes,. Manager LAramncstarsotnegr,, CPoreknnCsoymlvpaannyia.
Travelers P olicy No.
RUB 6220500
Dear S ir :- Please note d isp o sitio n piade o f the follow ing claim:
Date of Accident:
October 28, 1957
Claimant:
JamesShepherd
Location: Claim N o.; D isp o sitio n :
Everett, Mass. $5,269001..0209 -- MCoemdpi.cal
139765 - Expense
REVISION
Remarks:
/1
b
Indicate Whether: WAuotrokmLenia'sb iCloitmyp._B_._I.______ General L ia b iliPty.DB._._I_.
P.D.
sjm
Very truly yours, ALEXANDER & ALEXANDER INC.
LO/SSJ .DEPARTMENT
0
BALTIMORE ' ` NEW YORK CLARKSBURG' TULSA , ST. LO U IS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA
A l J S X A N D K R S&Ai - EXATCOl Ef f e
INCORPORATED
INSURANCE
AVERAGE ADJUSTERS
CONSULTING ACTUARIES
. . < f-, --U' . r 1v~ 2225 NORTH CH ARLES STREET, BALTIMORE 18, MD. / , A pril 25, 1961
VM n
m
TELEPHONE TUXEDO 9-4304
beLl system TELEjTYPE BA 582
CABLE ADDRESS
"A|LQ XBLUE"
Mr. William L. Hughes,. Manager Insurance Department Armstrong, Cork Company Lancaster, Pennsylvania.
Travelers P olicy No.
RHB 6220500
Dear Sir:-
Please note disposition made of the following claim
Date of Accident: Claimant: Location: Claim No.: Disposition:
Remarks:
October 28, 1957 James Shepherd E verett, Mass. B-8602114 $5,064001..0209 -- MFaetdailcal
139.65 - Expense
Indicate Whether:
Workmen's Comp. x Auto Liability B.I.___
P.D.___ General Liability B.I.
P.D.
sjm
Very truly yours, ALEXANDER & ALEXANDER INC.
LOSS DEPARTMENT
"
BALTIMORt NEW YORK CLARKSBURG TULSA
ST. LO U IS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA
Alexander <&iSdUEXAraoiEiR
INCORPORATED
INSURANCE
AVERAGE ADJUSTERS
CONSULTING ACTUARIES
2225 NOR TH C H A R L E S STREET, BALTI MORE 18, MD.
October 13th, 1960
TELEPHONE TUXEDO 9-A304
BELL SYSTEM TELETYPE BA 582
CABLE ADDRESS "ALEXBLUE"
Hr. R. C. Schiedt, Jr. Insurance Department Armstrong Cork Company Lancaster, Pennsylvania
1 H! .?jA l\ vjtj*
Dear Mr. Schiedt:
re: James Sheppard
WFoirlekmen'Bs 86Co0m2p1e1n4sation - Mass.
We are advised by the Travelers Insurance Company
$th5a,6t4 1th.2is9 , case was settled by a lump sum agreement in the amount of on the p o s s ib ility thTaht ethTeraSvtealteers,ofhMowaesvsearc,huasreettshomldaiyngf i lteheaf cillaeimopen uisndeenr tSitelcetdionto 65$N50o0.f ftohre aGefnaetraall Linadwus,stCrihaalptcearse152Inin thwehiechventhteaSctlaatiem aismofuinlet.d Tthoeydaftee,e l,nohnoewheavserb, eetnhaftiltehdeybmuatythbeeyaabrlee rtoeqcuoirmepdrotmoisheotldhatthe case open for a reaspnabje period of time to see i f a claim is made. advise you o f developmWeenwtsi.ll follow up the matter in due course and
Sincerely
ALEXANDER & ALEXANDER, INC.
March 2, 19<50
MArrm. JstorhonngXC. oZnetrlalecrting end Supply Corporation 1L2a0ncKa.stleirn,eP8at.re a t Dear John/ Subject 'AwasnbeesstRo.siSs hCeplahieirid Wtinheen tthhee dseetcteledmenetnwt ofrikgeudrefoorfyoovurerco$m5p0a0n0y,isthecoomupta-roedf-ctooutrhte sleetntlgetmh eonft tsheeamt saerxetarasovnsgabanlet. seWttlheenmceonmt pvaarsedetfofecthteedp. otential, however, i t eppe&rf Vamitohunrtegoafrdtheto atwhaerdl,a sthteeCmopmlomyeerrcebCeilnegarhinegldHroeusspeoInnsfiobrlme aftoiornthSeenfduelel oinn Wwhoirckhmathn'issCvoamsphenesldatitoon,bteo thwehicchasves. sTubhsiscriisben, olti sptescusleivarertaol Mcaassesas vcahsusaeltstos hsienldcetowebkenoswoloelfy sreevseproalnsoibthleerfostratthees wawhaerrde. thIenlasosmt eeomfpltohyeer . esmtaptleosy,erhsowanedv/eor,r tahneaipr pionrstuiornamnceentcparrorcieeerds inagreihs epldermreistpteodnswibhleerebfoyrfoarmer opfarttimoef tthhee tcolatiaml aanwt avrads, wphilcohyepdaratnlda inusaucatlulyalbaosoendtaucptonwitthhethleengcothn pdrioticoenedwinhgicihs cpenesrmedittthede idnisMeaasses.achVuesedottsn. ot know i f an apportionment yI of uardwdoitrikomneanl'spcreocmapuetniosantsionoocuoldstbseantadkfutusrtethraetetismwe ooufldcpelortyaainelnyt, show the f&rorable resu lts o f these measures.
Sincerely yours,
v *
WA saslliasctaenBt.GHeonfefroarlthManager
JEZ
Insurance Department
Arm strong
contracting and supply
CORPORATION
TELEPHONE: EX
70*3!
120 NORTH L I M E S T R E E T
LANCASTER,PENNSYLVANIA February 29, I960
Mr. W. B. Hofferth Armstrong Cork Company Liberty and Charlotte Streets Lancaster, Pa.
Dear Wally:
Subject: James R. Shepherd Asbestosis Claim
We attach a copy of a letter dated February 19 from John Roper reporting on the settlement in the asbestosis claim for one James R. Shepherd. This man worked for us for less than two months and to me it seems the $5,600 settlement is, to say the least, high.
Your comments will be appreciated.
Very truly yours,
DB Enclosure
and Warehouse Operations
jjncjoe/ji
E n d e sure
i
A r m s t r o n g -------' C O N T R A C T I N G A N D S U P P L Y CORPORATION T E L EPH O N E: E X p r i s i 7.3631
120 NORTH LIMI IT R IIT
LANCASTER. PENNSYLVANIA
February 29, I960
AMrrm. sVtr.oBng. HCoorfkfeCrtohmpany LLiabneeratsytesro,dPaC*harlotte Streets Bear Vallyj SubJeeti [AJasmbeessRto. sSrThexprhaerd Hreepaotrttainchg oanctohpey osefttalelme ettnetrIndattheed Fasebberustaorys!#19cflaroimm JaanmdetsoRm. eShi tepsheeermd.s thTehi$s5m6a0n0wsoertkteldemfoenr tuiss f, otrolesasys Tour comments w ill be appreciated.
Very tru ly yours,
JfoohrnoRneoper tthha#nletwaostm, ohnitghhs.
DB
and Warehouse Operations
\ Enclosure R. C. Schidt, J r ., Armstrong Cork Co.
May 12, 195
T14h7e-1T4r9avMeliallre*SItnraeuertane Coapany Boston 9, Haas. Gentienea*
O / f i ~~ / 0 / * ^A2
nVaeahteveithnoAtemdsttrhsmgvagCaorrkeoCoaradpaonyf JoanmtehsSahtetpahcahreddeofoverari.ngFhleiseseant iortee thapllo&y-st tuo itesas repreeent vagas earned after th allegad date of th aeeidant.
AInrmrsitronogfCtohrk nCaotauproenyo, fythimoaglainiae oaudr lhiia bvielriytyllailltie dbeeaplalooysateanltl.ith
Very truly your,
ARMSTIDSa 00BC COMPAHI
JEZ Sacio sare
RIn*s0arnSccehiDedetp,aJrtra*ent
*
WNeoe.k ! WNeoe.k
1.0'j-2fc8c-^esS-tto 10-28-57--7 THE TRAVELERS INDEMNITY COMPANY
. ^,:.
EWmApGloEyeSrT AT/xEnMsEtNreTn: gCork Co__________
Fmployee Jones ShepherPdR_E_P_A__R_E__IN__D__U_P_L_IC_A_T_E
File Nr> B-8602Illl Flyaij--B____ Date of Accident:
_____________ Date of Hire*_______________ --
PLEASE FURNISH FULLY THE FOLLOWING IMPORTANT INFORMATION
1. Number of children under 18 years of age:----- --------------------------------------------------------
2. Dependents other than children:--------- -----------------------------------------------------------------
3. Has employee been certified by U. S. Veterans Administration for any type of disability?.
4. Ta hfeellfoowlloewminpgloiyseea itnrutehecospaymeofcltahses opfayermolplloreycmoerdnt.of the above employee or of________
Payroll Record--see Instructions below*
Signed:_________________
T itle :___________________
Week nding
AmInoculundtiPngaid Overtime
NMoe.aolsf Per
Wk.
WFuarsnRisohoedm Employee?
Year Weekl Ending
AmInoculundtiPngaid
NMoe.aolsf Per
Overtime Wk.
Month Day
19 2
2SU*
1103957*8404
Vm
Month ' Day 27 28
3 190
4 ID
136
123753..8500
No
29
If Tips or other 30
5 6
1100
2207
3328837.0342
eBde,ndefeistscwriebreeeaanrnd 31 state value per 32
*
7 8
1111
3
lo
1534775782
week.
33 34
9
35
10
36
11
37
12
38
13
39
14
40
15 16
41 42
*
17
43
18
44
19
45
20
46
21
47
22
48
23
49
24
50
25
51
26 TOTAL
1,436,40
52 T otal
1 ^ 3 (0 y o
h*aInsdwicoartkeeodnblyutthaossehowrat gteims ee,arsnuebdstbityutienjwuraegdesemofpalofyeelelowduerimngplo5y2ewe eienktpheerisoadmiemcmlaesdsiaotfeleympprleocyemdienngt aacncdidwenhto. haIsf winojurkreedd
for a substantial portion of the 52 week period._________________________________________________ i______________
FOR INSURER'S USE ONLY
D ivisor
T(Motinaul.sWDaegdeusctions)
WAveeerkalgyeW age
CRoamtepensation
(space for insurer's explanatory note or figuring)
0 4 2 3 1 P R IN T E D IN U.S.A.
ARMSTK3BG CORK COMPARI
Insurance Department
INTER O F F I C I C O M M U N I C.ATION
-------- ( A r m s t r o n g
To
frflTrn-Pi-p. A C & S , L a n c a s t e r
From F. H. S h e r m a n , A C & S , B o s t o n
H a y 7, 1958
Subject
Request for Wage Information James Shepherd
A t t a c h e d p l e a s e find The Travelers Insurance Company f o r m #C~1|231, r e q uesting wage information on one James Shepherd. Mr. Shepherd w o r k e d f o r us f r o m S e p t e m b e r 17, 1 9 5 7 to N o v e m b e r i|, 1957
Vie w o u l d a p p r e c i a t e y o u r h a v i n g th e a t t a c h e d f o r m c o m p l e t e d a n d r e t u r n i n g it to T r a v e l e r 's at llj.7-- li+9 M i l k Stre e t , B o s t o n 9, Mass.
dn Enc.
FORM 31501 12*57
April U* 195
MAlre. xJamndaer fXt.ATlaeaxnaennder, Zno. B22a2l5timHoorreth1C8,haMrlde.a S treet Dear Jiml // Subj act* 1/WBtoprklomyaene1- CJoomsepesnsRa*tioSnhe-paMrdae* mthoeaterneccloesnetddeovopelyopomf eanntinintrat-hoeoaapbaonvye mcleamimor*anduTmhedaalteledgeAdpriinlju7ryeehtaadfoberethn trhe*e ported to the Boston office of The Travelers on Pabruaxy 1* WpleovyiesrhotfoJapmoeins tSohuept atrhda, tthalitshoiusghnoitt alastabteelmieevnetdotfhfaatsvteavsevree hthaevelanos tknemow~ledge othfiSshienpfaordrm* satieomnploonymteontTfhoellTorwaivneglerhsi*s Short tour of duty with us* Please pass
Sinoerely yours,
JXZ Enclosure {Letter in duplicate)
WA saslliasctaenBt*GBeoneffrealrtMh anager Insurance Department
*
A r m s t r o n g C O N T R A C T I N G A N D S U P P L Y corporation
Subsidiary
of
Armstrong
Cork
Company
120 NORTH L IM E S T R E E T
LANCASTER. PENNSYLVANIA
T\*1*3?, & 3 u li!
April 10, 1958
Mr. E. G. Fiedler Legal Department Armstrong Cork Company Lancaster, Pennsylvania
Dear Ed:
Subject: James R. Shepard c o3s- --o'/-& t f o
Attached is a copy of an inter-office communication received from our Boston district manager, Mr. J. J. Roper. This communication has to do with certain contacts which he has had with the Commonwealth of Massachusetts, Division of Industrial Accidents, in connection with an ex-Armstrong Cork Company employee.
I am sure that Mr. Roper or any other employees of our company who can be of any help to you in this matter will be glad to cooperate with your office.
Very truly yours,
ASROMPSHTRJjOPN&GOCROANTTRIOACNTING AND
A Enclosure
'Emmet t ^ .`'Sines, Jr. Secretaiy-Treasurer
INTER OFFICE COMMUNICATION
To J . V. L id d e ll, ACAS, L ancaster From J . J . Roper, AC&S, Boston
Subject Janes R. Shepard
sAs ,, xr' <mo. **s<t.r o*<n g
April 7, 1958
PERSONAL
Dear Jim:
Qp February 3rd, we repaired a coaacvinlgatioo fro The Coesonwealth of Massachusetts. Division of Industrial Accidents, dated January 31. iQ5flT indicating that~"lhe Abuts-liMAd "ME o was a Pipe Coverer and who worked forus frn September if t iy5Y to ovember h, 1957. had an * accident on the job. *e had no record of any accident and our foreman intUcAlAi tfiat^none was reported to him. On February Ij, 1958, upon receipt of the communication, Frank Sherman nailed in an accident report forn giving the nan's name and address and other statistics, and quoted
NPasiopvefeomlCbleoorvwesUr:i,ng19"aT5nh7di..s..B..n.l.oahncakvweaastnoejomrbpelco(oiyfreyddwtobicyf aaSnstyaftairoconci,deBnotstoonnyyjE^oldb7is.,.o.wn19a5Cs7omatppoapnlyy)i"n.g AoffeIwndduasytsriaagloA, cwchiednenItsw, aCs oomuotnowfeathlteh ooffficMea, sMsarc*hGusierottusx, 1o8f tThreenDanivt iSsito.n, Bhaodstodnie,d, caapllpeadreanttlytheefosfofmicee luanngd dadisvoisredderFaranndkthSahtera"ahnisthwaifteJainnteesndSehdepard ttohesureestuhlet AofrmhsitsronwgorCkionrgk fCoormptahney AclramimstirnogngthCaotrkthCeomcpaaunsye. o" f death was JparmobesabSlyhesppaerdntwaasmainPorlapstaerrterofwhoirskinwgorokninga lpiefremiatsasa aPipPeipeCoSveevreerre. r Of cseovuernsewietekiss, hqeuioteouoldbvhioaursdlythhaatvein cwonotrrkaincgtedfearnuysthfinogr ainptehriiosdleonfgothnlyof tliamset EwmhipclhoyceorualdndhMavr*e Greisrouultxedtoilnd FhriasndkeSathhe*raanWtehbaetlitehvies wthaast pwroebaarbelyhis Ywohuy hwiisllwniofetewtahsabtritnhgeintigmeacdtiuorningagwahinicsht thhee wAorrkmesdtrofongr uCao,rkheCowmapsaniyn. the Semuppplolyy oCforpth*e Armstrong Cork Company, not the Armstrong Contracting and
f./ iiYSTANDARD FORM FOR -m* jptloy-er's First Report of Injury
Approved by I. A. I. A. B. C.
Complete this form promptly after iniurY occurs. Send original to Division of Industrial Accidents Ninth Floor, 18 Tremont Street, Boston 8, Mass.
Send copy to Claim Deportment THE TRAVELERS INSURANCE C O M PA N Y
147-149 Milk Street, Boston 9, Mass.
FEB 'I 1958
S tate's Number For:
File: ... Carrier: . Employer:
Carrier's File No. (The spaces above not to be filled in by Employer)
Employer aTnimd e Place PInejrusroend
oCfause Injury
1. 2. 3.
NO(afa)fmiceSetaaotdefdrnEeasmms:pelNooyofe.rinasnu<rfa"Sncte.. 2co'm/Opan''yF'wiirths tw' h!A'o`cmvoynouunare" .iCnistuyredo,rt.oT`po.r.wp..v.ni..'d..K,.e,..o.p..da.ySm'ieantrit'o; Lin'-jjufrcesd'
em. Sptl,oayteee..s...unde*r
th,
Workmen's Compensation A ct........ THE TRAVELERS.INSURANCE COMPANY.....................
(b) If not so insured, give number of employees on date of this report.......... ............
4. Give nature of business (or article m anufactured).......................................................r- Si\
5.
((.ba. .))
PLpl,oaccaetiown,heor.ef
ipnlj.aunryt
.
oi
ic
oc..us.r.tr..oe..d.n.........................................(.c..)....t.S..ot..a..t.e....i..f...i
Dep njur
a y
r.tomc.CeinirtredTjorn-
ot
r i
oc ft
e.mS..p.tlo,ayte,iro.s...n.p..r.,.e..m..L..isVe.s?c.f c o t t
6. Date of Injury........................................... 19................Day of week............................Hour of day . , t AM .. io p .n
7. Date disability began................................................19........... A .M ... . . . .P.M. 8. Waa injured paid in full for this-day.
9. When did you or foreman first know of in ju ry ...
........................... .....................................................................
10. Name of foreman. Q^nvr'v fren..................................................................................... .
11. Name of injured........ ......................................................^.............................(.M...i.d.d..l.e...I..n.i.t..i.a.l.)...................................................(.L..a..s.t...N..a..m..e..).........
1123.. CAhdedcrkes(sV: )NoM. aarnridedS..t..*..,....,1SSi"n gGle'f.'.O...I.IW' t idt oPw0ed6..1.............W.....iCdiotyw err...^......, Divorced.........; M a..l.e...-...........,.-...F..Setmatea lFei.r..e..S....*....V..
14. A ge........j/Q ....D id ynoC*u have on file employment certificate or perm it....................................C..*...........................................
15. ('a)' O~ ccupation w'hen `injured' . . v ^ '&'*....................... (b) Was this his or her regular occupation.'.g . ..
(If not, state in what department or Dranch o f work regularly employed) ..........................................................................
16. (a) How long employed by you . _ ... ,, . ...........(b) Piece or time worker,
(c) Wages per hour
17. (a) No. hours worked per day. . . . . . . F Y ......................(b) Wages per day $. ... o*?. 9 /- ...............................................
(c) No. days worked per w eek..........r f .................................(d) Average weekly earnings $ . . . s. *.',. f i n . ..........................
(e) .Where applicable give number of meals furnished employee each week, and estimated value per day, week, o
month of any lodging, fuel or other advantages furnished employee....................................................................................
18. Machine,- tool or thing causing in ju ry .................................................................... 19. Kind of power (hand, foot, electrical
steam, etc.)................................................................ 20. P art of machine on which accident occurred........................................
21. (a) Was safety appliance or regulation provided.............?............................... . . (b) Was it in use at tim e......................
22. Was accident caused by injured's failure to use or observe safety appliance or regulation...............................................
23. Describe fully how accident occurred, and state what employee was doing when injured.'..............................................
rtxi ri ;l ti)i
'' rnik 'i Yr 'itcelVr'fr'.ny T' l o'
'Aitd?''
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i
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'to y
si1. '? ;' f ' ira ? , ijj_ 1157"
2'4'.''N'a'Jmh'ersVancdjr'a.dTdresseFs 'opf Zwii/tne'ssceHs..v......r...i....h..vy...'...r.....c..l...'...b...l..c...r..'...c..l...'...a. f, ..'......U...o..v...o....'r'. ...n..o.........
25. Nature and location of injury (describe fully exact location of amputations or fractures, right or left).
Nofature Injury
26. Probable length of disability.......... If so, date and hour ...........................
28. At what occupation............................. 29. Name and address of physician. ...
(b) Name and address of hospital.
.27. Has injured returned to work........ ..........................................A t what wage $.
FCaatsaels Firm
30. Has injured
nam e................-.L...i.t...A........
died....................................................................................................if
.............................' . . . . : ............... Signed by
. .v-
so, give date of death.
: NOfficial^Xjtl^c.'Q
C--7340 1--55 P rin tea in U.S.A
Date of this report.........................